Effectiveness of Individual and Family Self-Management Combined mHealth Program for People with Stage 3 Chronic Kidney Disease: A Randomized Controlled Trial

Authors

  • Sangrawee Maneesri Faculty of Nursing, Burapha University, Thailand.
  • Khemaradee Masingboon Assistant Professor, Faculty of Nursing, Burapha University, Thailand.
  • Nujjaree Chaimongkol Associate Professor, Faculty of Nursing, Burapha University, Thailand.

DOI:

https://doi.org/10.60099/prijnr.2023.260340

Keywords:

Chronic kidney disease stage 3, Diastolic blood pressure, Family support, mobile health application, Self-management behaviors, Systolic blood pressure

Abstract

The rising prevalence of chronic kidney disease is a global and Thai public health concern and self-management strategies may be an effective way to help prevent its progression. This randomized controlled trial tested the effectiveness of the Individual and Family Self-Management Combined mHealth Program for People with Chronic Kidney Disease. Forty people with stage 3 chronic kidney disease were randomly assigned to either the experimental (n = 20) or control group (n = 20). The research instruments included the research protocol, the Healthy Kidney application, the Self-Management Behaviors Questionnaire, and the Clinical Outcomes Record Form. The outcomes of the program were evaluated three times, at baseline (week 1), immediately post-intervention (week 4), and at follow-up (week 16). An independent t-test and repeated measures analysis of variance were used in the data analysis.
Results indicated that during follow-up, the experimental group had higher self-management behaviors and lower diastolic blood pressure than the control group. The self-management behaviors, and systolic and diastolic blood pressure of the experimental group significantly improved three months after the intervention. However, the glomerular filtration rate was unchanged. The findings demonstrated that the program effectively improved outcomes for the participants.
The results of this study suggest that the Individual and Family Self-Management Combined mHealth Program can help people with stage 3 chronic kidney disease improve their self-management behaviors and alleviate blood pressure. This study supports the health care context to promote home-based self-management and guide the future development of mHealth applications. Further testing of the program is needed before incorporating it into nursing practice.

References

World Health Organization. mHealth: use of appropriate digital technologies for public health. 2018 [cited 2022 Oct 29]. Available from: https://apps.who.int/gb/ebwha/pdf_files/ WHA71/A71_20-en.pdf

Hamine S, Gerth-Guyette E, Faulx D, Green BB, Ginsburg AS. Impact of mHealth chronic disease management on treatment adherence and patient outcomes: a systematic review. J Med Internet Res. 2015 Feb 24;17(2):e52. doi:10.2196/jmir.3951.

Yi JY, Kim Y, Cho Y-M, Kim H. Self-management of chronic conditions using mHealth interventions in Korea: a systematic review. Healthc Inform Res. 2018;24(3): 187-97. doi:10.4258/hir.2018.24.3.187.

Tsai Y-C, Hsiao P-N, Kuo M-C, Wang S-L, Chen T-H, Kung L-F, et al. Mobile health, disease knowledge, and self-care behavior in chronic kidney disease: a prospective cohort study.J Pers Med. 2021;11:845. doi:10.3390/jpm11090845.

Kosa SD, Monize J, D’Souza M, Joshi A, Philip K, Reza S, et al. Nutritional mobile applications for CKD patients: systematic review. Kidney Int Rep. 2019;4(3):399-407. doi:10.1016/j.ekir.2018.11.016.

Welch JL, Astroth KS, Perkins SM, Johnson CS, Connelly K, Siek KA, et al. Using a mobile application to self-monitor diet and fluid intake among adults receiving hemodialysis. Res Nurs Health. 2013 Jun;36(3):284-98. doi:10. 1002/nur.21539.

Yang Y, Chen H, Qazi H, Morita PP. Intervention and evaluation of mobile health technologies in management of patients undergoing chronic dialysis: scoping review. JMIR Mhealth Uhealth. 2020;8(4):e15549. doi:10.2196/15549.

Morton K, Dennison L, May C, Murray E, Little P, McManus RJ, et al. Using digital interventions for self-management of chronic physical health conditions: a meta-ethnography review of published studies. Patient Educ Couns. 2017 Apr;100(4):616-35. doi:10.1016/j.pec.2016.10.019.

McManus RJ, Little P, Stuart B, Morton K, Raftery J, Kelly J, et al. Home and online management and evaluation of blood pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial. BMJ. 2021;372:m4858. doi:10.1136/bmj.m4858.

Whitehead L, Jacob E, Towell A, Abu-Qamar M, Cole-Heath A. The role of the family in supporting the self-management of chronic conditions: a qualitative systematic review. J Clin Nurs. 2018 Jan;27(1-2):22-30. doi:10.1111/jocn.13775.

Welch JL, Johnson M, Zimmerman L, Russell CL, Perkins SM, Decker BS. Self-management interventions in stages 1 to 4 chronic kidney disease: an integrative review. West J Nurs Res. 2015 May;37(5):652-78. doi:10.1177/ 0193945914551007.

Lee JA, Choi M, Lee SA, Jiang N. Effective behavioral intervention strategies using mobile health applications for chronic disease management: a systematic review. BMC Med Inform Decision Making. 2018 Feb 20;18(1):12. doi:10.1186/s12911-018-0591-0.

Kidney Disease Improving Global Outcomes (KDIGO). KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3(1):1-150. doi:10.1038/kisup.2012.73.

Curtin RB, Mapes DL. Health care management strategies of long-term dialysis survivors. Nephrol Nurs J. 2001 Aug;28(4):385-92; discussion 393-4.

Ryan P, Sawin KJ. The Individual and Family Self-Management Theory: background and perspectives on context, process, and outcomes. Nurs Outlook. 2009 Jul-Aug;57(4):217-25.e6. doi:10.1016/j.outlook. 2008.10.004.

Grey M, Knafl K, McCorkle R. A framework for the study of self- and family management of chronic conditions. Nurs Outlook. 2006;54(5): 278–86. doi:10.1016/j.outlook.2006.06.004.

Ong SW, Jassal SV, Miller JA, Porter EC, Cafazzo JA, Seto E, et al. Integrating a smartphone–based self–management system into usual care of advanced CKD. Clin J Am Soc Nephrol. 2016;11(6):1054-62. doi:10.2215/CJN. 10681015.

Doyle N, Murphy M, Brennan L, Waugh A, McCann M, Mellotte G. The “Mikidney” smartphone app pilot study: empowering patients with chronic kidney disease. JORC. 2019;45(3):133-40.

Nguyen NT, Douglas C, Bonner A. Effectiveness of self-management program in people with chronic kidney disease: a pragmatic randomized controlled trial. J Adv Nurs. 2019 Mar;75(3):652-64. doi:10.1111/jan.13924.

Lin C-C, Tsai F-M, Lin H-S, Hwang S-J, Chen H-C. Effects of a self-management program on patients with early-stage chronic kidney disease: a pilot study. ANR. 2013;26(3): 151-6. doi:10.1016/j.apnr.2013.01.002.

Schulz KF, Altman DG, Moher D; CONSORT Group. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med. 2010 Mar 24;8:18. doi:10.1186/1741-7015-8-18.

Faul F, Erdfelder E, Buchner A, Lang A-G. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009; 41(4):1149-60. doi:10.3758/BRM.41.4.1149.

Zimbudzi E, Lo C, Misso ML, Ranasinha S, Kerr PG, Teede HJ, et al. Effectiveness of self-management support interventions for people with comorbid diabetes and chronic kidney disease: a systematic review and meta-analysis. Systematic Reviews. 2018;7(1):84.doi:10.1186/

s13643-018-0748-z.

Curtin RB, Walters BA, Schatell D, Pennell P, Wise M, Klicko K. Self-efficacy and self-management behaviors in patients with chronic kidney disease. Adv Chronic Kidney Dis. 2008 Apr;15(2):191-205. doi:10.1053/j.ackd.2008.01.006.

Sritarapipat P, Pothiban L, Panuthai S, Lumlertgul D, Nanasilp P. Causal model of elderly Thais’ self-management behaviors of pre-dialysis chronic kidney disease. Pacific Rim Int J Nurs Res. 2012;16(4):277-93.

Chen YC, Chang LC, Liu CY, Ho YF, Weng SC, Tsai TI. The roles of social support and health literacy in self-management among patients with chronic kidney disease. J Nurs Scholarsh. 2018 May;50(3):265-75. doi:10.1111/jnu.12377.

Fakih El Khoury C, Crutzen R, Schols JMGA, Halfens RJG, Karavetian M. A dietary mobile App for patients undergoing hemodialysis: prospective pilot study to improve dietary intakes. J Med Internet Res. 2020;22(7):e17817. doi:10.2196/17817.

St-Jules DE, Woolf K, Goldfarb DS, Pompeii ML, Li H, Wang C, et al. Feasibility and acceptability of mHealth interventions for managing hyperphosphatemia in patients undergoing hemodialysis. J Ren Nutr. 2021 Jul;31(4): 403-10. doi:10.1053/j.jrn.2020.07.009.

Yang FJ, Hou YH, Chang RE. The impact of a social networking service-enhanced smart care model on stage 5 chronic kidney disease: quasi-experimental study. J Med Internet Res. 2020 Apr;22(4):e15565. doi:10.2196/15565.

Lu X, Yang H, Xia X, Lu X, Lin J, Liu F, et al. Interactive mobile health intervention and blood pressure management in adults. Hypertension. 2019 Sep;74(3):697-704. doi:10.1161/HYPERTENSIONAHA.119.13273.

KDIGO Blood Pressure Work Group. KDIGO 2021 clinical practice guideline for the management of blood pressure in chronic kidneydisease. Kidney Int. 2021 Mar;99(3S): S1-87. doi:10.1016/j.kint.2020.11.003.

Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Hypertension. 2018 Jun;71(6):1269-324. doi:10.1161/HYP.0000000000000066.

Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension. 2020 Jun;75(6):1334-57. doi:10.1161/HYPERTENSIONAHA.120.15026.

Jo SH, Kim SA, Park KH, Kim HS, Han SJ, Park WJ. Self-blood pressure monitoring is associated with improved awareness, adherence, and attainment of target blood pressure goals: prospective observational study of 7751 patients. J Clin Hypertens (Greenwich). 2019 Sep;21(9): 1298-304. doi:10.1111/jch.13647.

Sheppard JP, Tucker KL, Davison WJ, Stevens R, Aekplakorn W, Bosworth HB, et al. Self-monitoring of blood pressure in patients with hypertension-related multi-morbidity: systematic review and individual patient data meta-analysis. Am J Hypertens. 2020 Mar 13;33(3):

-51. doi:10.1093/ajh/hpz182.

Lee JY, Park JT, Joo YS, Lee C, Yun H-R, Yoo T-H, et al. Association of blood pressure with the progression of CKD: findings from KNOW-CKD study. Am J Kidney Dis. 2021; 78(2):236-45. doi:10.1053/j.ajkd.2020.12.013.

Lee MC, Wu SV, Hsieh NC, Tsai JM. Self-management programs on eGFR, depression, and quality of life among patients with chronic kidney disease: a meta-analysis. Asian Nurs Res (Korean Soc Nurs Sci). 2016 Dec;10(4): 255-62. doi:10.1016/j.anr.2016.04.002.

Peng S, He J, Huang J, Lun L, Zeng J, Zeng S, et al. Self-management interventions for chronic kidney disease: a systematic review and meta-analysis. BMC Nephrol. 2019 Apr 26;20(1):142. doi:10.1186/s12882-019-1309-y.

Chen X, Xie S, Yu X, Chen Z, Zhuo M, Li J. mHealth app for patient self-management of chronic kidney disease improves renal outcome: pilot study. JMIR Publications. iproc 2018;4(2):e11777. doi:10.2196/11777.

Nojima J, Meguro S, Ohkawa N, Furukoshi M, Kawai T, Itoh H. One-year eGFR decline rate is a good predictor of prognosis of renal failure in patients with type 2 diabetes. Proc. Jpn. Acad., Ser B. 2017;93(9):746-54. doi:10. 2183/pjab.93.046.

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Published

2022-12-14

How to Cite

1.
Sangrawee Maneesri, Khemaradee Masingboon, Nujjaree Chaimongkol. Effectiveness of Individual and Family Self-Management Combined mHealth Program for People with Stage 3 Chronic Kidney Disease: A Randomized Controlled Trial. PRIJNR [Internet]. 2022 Dec. 14 [cited 2024 Oct. 6];27(1):169-84. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/260340

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